A bill to amend title 38, United States Code, to authorize the Secretary of Veterans Affairs to furnish care for newborn children of women veterans receiving maternity care, and for other purposes.

Mr. President, I rise to introduce the State Children's Health Insurance Program, SCHIP, Expansion Act of 2004. This Congress passed the Children's Health Insurance Program in the late 1990s. It has been a great success. There are 5 million American children today who have quality medical insurance because of this program; without this program there would be another 5 million Americans uninsured.

The expansion of this legislation in 2004 would allow States to expand health coverage under the SCHIP program to all uninsured children, regardless of their family income. It would also provide critical funding for this important program.

This week is Cover the Uninsured Week. This is a collaborative effort of the Robert Wood Johnson Foundation and many other organizations highlighting the vast number of uninsured in this country and the need to find a solution.

Yesterday, I introduced legislation with Senators Daschle and Kennedy which will call for the Nation to cover all Americans by the year 2006. The goal of universal coverage is one that I believe every Member of this Senate

shares. Based on the experience of the last decade, it is my judgment that the road to achieving that goal of full coverage begins with a first step. We have not taken a significant first step on the road to closing the gap now in over 5 years. In that 5-year period, we have seen a dramatic increase in the number of uninsured Americans, including uninsured children.

We could take that first step by providing health coverage for all children. That step will be a large one.

Today, there are an estimated 9 million American children under the age of 19 who are uninsured for their health care. Over 640,000 of those children live in my home State of Florida. There are other large groups of uninsured Americans, however, and one might ask, why pick out children from this large group of uninsured Americans? The goal is to cover all Americans. The reality is the effort to accomplish that objective in one giant step has proven to be without success. Uninsured children, in my judgment, represent the group that we should start with, for the following reasons.

We know this about uninsured children: They are four times more likely to delay seeking care than insured children, and they are five times more likely than insured children to use an emergency room for regular medical care. Lack of timely treatment can turn a simple health problem into a serious childhood illness. Covering children is cost effective, and more important, it improves the lives of children. It can, in fact, save the lives of children. Let me give two common examples.

Ear infections are a very common affliction of young children and easily treated with an inexpensive antibiotic. However, if that ear infection is not diagnosed and not treated, the infection can mature into deafness and learning disabilities. What happens when an unvaccinated child is struck with bacterial meningitis? Failure to diagnose and treat this contagious disease with an antibiotic can lead to brain damage, even to death.

Our Nation's publicly funded health programs play a critical role in providing access to care in order to prevent such occurrences. As I said in the beginning, SCHIP has made an enormous difference in the health and lives of over 5 million American children, many of whom are from working families.

We know 8 out of 10 of the currently uninsured Americans come from a family in which one or both parents are working.

Despite the success of SCHIP, States have taken to such tactics as capping enrollment and placing limits on eligibility and benefits. I am sorry to have to report some of the things that have happened in my State, not because they are peculiar, but because they are increasingly representative of what is happening in States across America.

Until recently, Florida had amassed a waiting list of children who were eligible for the SCHIP program but who were not being served, primarily because of limitations on State funds to match the Federal funds. We had a waiting list of nearly 100,000 Florida children. Although most of these children have since been temporarily enrolled, the Florida SCHIP program has eliminated all outreach activities; that is, those activities that had informed families about the availability of these programs have been eliminated. Florida has also restricted eligibility for children in families whose employers offer any kind of dependent coverage, regardless of its cost.

If there is one thing we know, it is that one of the factors that is fueling the increase in the numbers of uninsured Americans is that even when employers provide at least the appearance of health insurance coverage but that coverage is so expensive that it amounts to more than 5, sometimes almost 10 percent of that family's income, and as available as it may appear, in real economic terms it is not available. Yet in my State, I am sad to report that a child who has fallen into that circumstance will not any longer be considered eligible for the SCHIP program.

Florida has eliminated its SCHIP waiting list. No one in the future will ever say that Florida has nearly 100,000 children who are eligible for but not receiving SCHIP coverage because there will not be any list of children who are waiting for their opportunity to be covered. This is a means by which knowledge of the number of uninsured children who are denied access to the program will be denied to the people of Florida, as will, therefore, their ability to influence public policy to increase the health care coverage of the children of Florida.

What would the legislation I introduce today do to address these problems? First, it would allow States to expand health coverage to uninsured children, regardless of the income, so that no child goes without necessary care.

Second, it would provide Federal financial support to assure the long-term stability of the SCHIP program. To meet congressional budget limits, Federal funding for SCHIP declined by over $1 billion a year, beginning in the fiscal year 2002, and running through the current fiscal year of 2004. That reduction, which is referred to as the CHIP dip, has brought the Federal funds available for children's health insurance from $4 billion annually down to $3 billion.

The consequence of this is that many States which had a fully operational SCHIP program--that is, they were using the full amount of the pre-2002 Federal funds--are now facing another component of their fiscal crisis.

The SCHIP Expansion Act would restore Federal funding allotments to their pre-2002 level, assurance that States could continue to cover more uninsured children.

The legislation would also invest additional resources in SCHIP, allowing States that are currently using all of their Federal funds to expand their programs, providing relief to many States that anticipate a shortage of funding in the near future.

The Center on Budget and Policy Priorities estimates that by 2007, on the current course, 39 States will have spent their entire funding allotments. Additional funds are necessary to allow these States to continue to reach new currently uncovered, uninsured children. Many of our uninsured children are, in fact, already eligible for coverage under SCHIP, but where you have limitations in Federal or State funds, they are not enrolled. Effective outreach and streamlined enrollment are keys to improving coverage.

SCHIP expansion will help States cover more children by increasing funds for outreach in States. That will simplify the enrollment process.

Finally, this legislation will prohibit States that have not exhausted all available Federal funds from capping enrollment in their SCHIP program. Where enrollment is capped, children are put on a waiting list--if the State has not done what Florida has done, which is to eliminate the waiting list, and they will go without coverage. Without coverage, their parents must choose between paying for rent and paying for medicine for their sick children.

Have we not reached a sad state of affairs in this Nation when many of our elder citizens have to make a choice between paying for prescription drugs or eating a nutritious meal three times a day, and that many of our parents of young children who are sick and without medical insurance must make a choice between paying the rent or paying for the medicine for their child?

My bill assures no family faces such a choice as a result of an arbitrary enrollment tax. States which choose to participate in SCHIP must be willing to participate fully and cover as many children as they can with the funds they have available. There is no reason in a nation of unsurpassed wealth and of unsurpassed medical talent that any child should be without health insurance coverage.

Investment in proven effective public programs is imperative.

Although our overall goal is universal coverage, assuring that all children have access to quality health care is a crucial first step. In my opinion, steps 2 and 3 should be to cover the working poor and the early retirees. These steps won't achieve the goal of full coverage even in conjunction with the full coverage of children, but they will significantly close the gap of those Americans today who are without health coverage.

The SCHIP expansion program represents a serious and long overdue commitment to expanding coverage for the most vulnerable in our society, our young boys and girls. This measure has

the support of the Children's Defense Fund, Catholic Charities USA, the Association of Maternal and Child Health Programs, and Families USA.

I ask unanimous consent that a letter of support be printed in the Record.

I call upon this Congress to act and to act this year to pass this important legislation, and to remove from the rolls of the uninsured for health coverage Americans, at least those most fragile and vulnerable, those we love the most, our children.

On Monday, the Government Accountability Office (GAO) released a report on the Trade Adjustment Assistance health coverage tax credit, HCTC. The report confirms what many in Congress have been saying since the HCTC program began--the credit is not enough, the program has several barriers to enrollment, the premiums are prohibitively high for some workers because of medical underwriting, and the program is very expensive to administer.

It is long past time for Congress to focus on the problems with the TAA health coverage tax credit. That is why I am introducing legislation today that will make much-needed improvements to the HCTC program. The TAA Health Coverage Improvement Act of 2004 offers solutions to many of the problems with the HCTC identified by GAO. This legislation will go a long way to make the TAA health care tax credit a realistic option for displaced workers and their families.

When Congress passed the Trade Act of 2002, we made a promise to American workers that the potential loss of jobs will not equal the loss of health care coverage. Unfortunately, Congress has failed to make good on that promise. For the last two years, I have heard from steel retirees and widows in my State about how unaffordable the TAA health care tax credit is. And I have been very frustrated, just as I was when this bill passed, that we were not able to make the credit more affordable and accessible for people who need it the most--laid- off workers and retirees who have very limited income.

For a good number of supporters of the Trade Act of 2002, the health insurance tax credit was the single most important factor in overcoming their concerns about giving the President fast- track authority to move trade agreements through Congress. In my own judgment, the fast-track would not have passed Congress without the health care tax credit. The TAA health credit was the trade-off to balance the President's authority.

Yet, the success many of us envisioned for the health care tax credit has not been realized through implementation. The number of people who have been able to access the health care tax credit over the last two years is extremely disappointing. As of July 2004, only 13,194 out of 229,044 who are eligible for the credit are enrolled in the program. That is less than six percent, which means that over 94 percent of those eligible are not participating.

I must say to my colleagues that Congress has had a hand in these disappointing enrollment figures. We have ignored every opportunity to improve the health coverage tax credit and enhance the lives of workers displaced by trade. Most recently, the members of this body voted against the Wyden-Coleman-Rockefeller-Baucus TAA amendment to the FSC/ ETI bill. Not only would this amendment have extended Trade Adjustment Assistance to service workers, it also would have addressed some of the problems GAO has identified with the health coverage credit.

The TAA Health Coverage Improvement Act makes long overdue improvements to the TAA health care tax credit. First, this legislation addresses the issue of affordability. In addition to GAO, several consumer advocacy groups and research organizations--including the Commonwealth Fund, the Center on Budget and Policy Priorities, and Families USA--have cited affordability of the credit as the primary reason for low participation in the HCTC program. The bottom line is that a 65 percent subsidy is not enough. With a 65 percent credit, an eligible individual still has to pay an average of $1,714 out-of-pocket per year for single coverage. This figure is particularly astounding given the fact that the average worker, while actively employed and earning a paycheck, paid just $508 in 2003 for single employer- sponsored health insurance coverage. The TAA Health Coverage Improvement Act makes the credit more affordable by increasing the subsidy amount to 95 percent.

This legislation also addresses the issue of affordability by placing limits on the use of the individual market, as Congress intended under the original law. The Trade Act of 2002 specified that the health insurance credit could not be used for the purchase of health insurance coverage in the individual market except for HCTC-eligible workers who previously had a private, non- group coverage policy 30 days prior to separation from employment. However, States have been allowed by this Administration to create state-based coverage options in the individual market for any HCTC beneficiaries, including those who did not have individual market coverage one month prior to separation from employment.

Because of the Administration's interpretation of the law, there are people who had employer-based coverage prior to separation from employment who are now being covered in the individual market. This was not the intent of the law. To make matters worse, this interpretation undermines the consumer protections set forth in the law because individual market plans are allowed to vary premiums based on age and medical status. In one State GAO reviewed for its report, because of medical underwriting, HCTC recipients in less-than-perfect health were charged almost six times the premiums charged to recipients rated in the healthiest category. The legislation I am introducing today addresses this problem by clarifying that states can only designate individual market coverage within guidelines of 30-day restriction and by requiring individual market plans to be community-rated.

Second, this legislation guarantees that eligible workers will have access to comprehensive group health coverage. Group coverage is what people know. The vast majority of laid-off workers and PBGC retirees had employer-sponsored group coverage prior to losing their jobs or pension benefits. The TAA Health Coverage Improvement Act designates the Federal Employees Health Benefit Plan (FEHBP) as a qualified group option in every State, so that displaced workers nationwide will have access to the same type of affordable, comprehensive coverage they were used to when they were employed.

Third, the TAA Health Coverage Act clarifies the three month continuous coverage requirement. Under the original TAA statute, displaced workers are required to maintain three months of continuous health insurance coverage in order to qualify for certain consumer protections. Those protections are guaranteed issue, no preexisting condition exclusion, comparable premiums, and comparable benefits. Congress intended this 3 month period to be counted as the 3 months prior to separation from employment. However, the Administration has interpreted the 3 month requirement as 3 months of health insurance coverage prior to enrollment in the new health plan, which usually is after separation from employment and after certification of TAA eligibility. Many laid-off workers and PBGC recipients cannot afford to maintain health coverage in the months between losing their jobs and TAA certification and, therefore, lose eligibility for the statutorily provided consumer protections. This legislation corrects this problem by clarifying that 3 months of continuous coverage means 3 months prior to separation from employment.

Fourth, this bill allows spouses and dependents to receive the health coverage tax credit. Over the last 2 years, younger spouses and dependents of Medicare-eligible individuals have not been able to receive the subsidy because eligibility runs through the worker or retiree. This technicality is unfair to individuals who rely on health coverage through their spouses or parents. The TAA Health Coverage Improvement Act allows younger spouses and dependent children to retain eligibility for the health coverage tax credit in the event the qualified beneficiary becomes eligible for Medicare.

Finally, this legislation streamlines the HCTC enrollment process and makes it easier for trade-displaced workers to access health insurance coverage. According to GAO, two of the factors contributing to low participation include a complicated and fragmented enrollment process and the inability of workers to pay 100 percent of the premium during the 3 to 6 months they are waiting to enroll in advance payment. This legislation includes a presumptive eligibility provision that allows displaced workers to enroll in a qualified health plan and receive the HCTC immediately upon application to the Department of Labor for certification. There is also a provision which directs the Treasury Secretary to pay 100 percent of the cost of premiums directly to the health plans during the months TAA-eligible workers are waiting for advance payment to begin.

As a former Governor, I know how important Trade Adjustment Assistance is to individuals who have lost their jobs due to trade. In West Virginia, thousands of workers have lost their jobs as a result of trade policy. While adjusting to the loss of employment, these individuals still have to pay mortgages, put food on the table, and care for their families. Finding affordable health care adds a significant burden to their worries. The TAA health coverage tax credit is designed to help American workers retain health insurance coverage during this very difficult transition.

Unfortunately, the HCTC program is not living up to its potential. The Government Accountability Office has given us a very specific diagnosis of the problems. Now, it is up to us to fix them. The TAA Health Coverage Improvement Act builds upon the Trade Act of 2002 and the lessons we have learned since in order to make the health coverage credit workable for eligible individuals and their families. I look forward to working with my colleagues to pass this important legislation.

I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I know the hour is late, and I will try to keep my comments fairly brief. I promise I will not take more than an hour or two.

What I am showing tonight is a picture of some American heroes. Oftentimes we look at a person in uniform and say: That's a hero. Certainly, the folks injured and killed in combat we see them as heroes. But you are really just a hero if you serve, if you put on your uniform and do your duty to your country.

The other heroes in this picture are this soldier's family. We can see they are hugging him and supporting him, and that is really part of the definition of a hero as well. Certainly, the folks who are not pictured here--this man's employer because he is probably in the Guard or Reserve, and folks in the community, people in his church or his neighborhood--whatever the circumstances may be--they are heroes in this picture.

We thank all of our soldiers who are serving bravely for our country, wherever they may be tonight. I want to thank the conferees, who worked so hard on the Working Families Tax Relief Act last week, for including the provisions of S. 2417, the Tax Relief for Americans in Combat Act or, as some people call it, TRAC.

One thing that TRAC was designed to do was eliminate the combat pay penalty. I introduced TRAC back in May of this year. The rationale for introducing TRAC was to help our men and women in combat. In fact, in my work on the Armed Services Committee, and with the help of Chairman Grassley and Ranking Member Baucus, the committee requested a GAO report. We became concerned in the Armed Services Committee about the tax package that is available to our soldiers, Marines, airmen and seamen. So Chairman Grassley and Ranking Member Baucus were gracious enough to request a GAO report.

In essence, what the GAO report found was a glitch in the Tax Code, an unintended consequence. Basically, what they found is that if one is a soldier and receives combat pay, which means they are in theater and they are in harm's way every day, they receive their combat pay and they want to claim their earned income tax credit, which many of these individuals are entitled to under our Tax Code, they actually can lose money on their taxes by receiving their combat pay. That is why I call it the ``combat pay penalty,'' because it really does disadvantage some people on their taxes.

I have a chart that illustrates what I am talking about. If someone is working in a hardware store 12 months out of the year, let's say they were making $16,000 a year annually, under the earned income tax system that we have on our books right now, $4,100 may possibly come back to him under the EITC. If that same person works in a hardware store, say, for 4 months, and he is in the guard or reserve and he gets 8 months for his military service and he makes the same $16,000, by the time he does the math and he fills out his tax form he is only entitled to $2,100 under the earned income tax credit.

What we are doing is, inadvertently we are putting our soldiers at a disadvantage. In other words, this soldier in this example has lost on his taxes about $2,000. Clearly, this is not the intent of Congress.

The way I feel about it--and I know a lot of my colleagues on both sides of the aisle feel about this--is while our brave soldiers are overseas fighting for us, we need to be in Washington fighting for them and their families. I think it is just incumbent upon us to recognize the principle that we need to take care of those who take care of us. There is no one in the world who is doing a better job taking care of us than our men and women in combat.

Under the provisions of a bill that I will file this evening, the provisions are very simple. What it will do is allow men and women in uniform serving in combat to include combat pay for the purpose of calculating their earned income and their child tax credit benefits. If that calculation works in their best interest, it gives them control over their taxes and allows them to make the determination for what is in their best interest on their taxes.

Again, I want to thank the conference, and the Senate, House, and the President for signing it, because we did win a short-term victory on this. We got this provision on the earned income tax credit for 2 years. Everything else in the bill was 5 years, but we did get 2 years. It is a short-term victory, something I hope we will be able to go back and change and make it a long-term solution for these brave Americans.

I do not want to speak to all the intricacies of the earned income tax credit because I have heard Senators in this Chamber say that it is basically a Tax Code for a welfare program. I disagree with that. We may have an honest disagreement about that. Clearly, our men and women in uniform receiving combat pay are working hard. We know this is not a welfare program for them. We know they are not going to abuse this or they are not going to miscalculate it. We have a high degree of confidence that this is going to be good for them and good for all of us.

Anyway, I want to draw the attention of my colleagues to the next chart, which is the earned income tax credit. This chart shows how it is structured. Depending on a person's situation, if they have no child, one child, two or more children, it shows a sort of range of possibilities, depending on what one's income is. Obviously, it is like a formula where the numbers have to be plugged in. It is different for different people.

As we can see, a soldier who is making, say, about $6,300 ought to get about $390 from the earned income tax credit. Whereas a soldier who is down on the income scale, making $1,400, should get about $2,600 in earned income tax credit. So, again, this will change depending on the situation.

What we are proposing would allow our soldiers, our men and women in uniform, to take advantage of an existing provision of the Tax Code and maximize it to their full advantage.

I am not saying that we can get this done this week. We certainly understand that we are out of legislative days, but I hope sincerely that we can come back in the lame duck session or whenever we reconvene and really get serious about helping our men and women in uniform.

We fixed the earned income tax credit for 2004 and 2005.

Here is another chart showing some of the numbers and how it would work, again, depending on how many months one is in combat. Just depending on the various losses that one might have, we can see based on this chart and the numbers here, the soldiers who are impacted the most are the enlisted men. Officers can be penalized under this, but the enlisted men and women are the ones who are probably at the greatest danger of losing their tax benefit.

One reason that Senators have decided to help me on this--we have, I believe 36 cosponsors now who have signed up to help out on this--is because it is a cheap fix. When we look at the numbers for 2 years, 2006 and 2007, we are only talking about $15 million. When we talk about taxes in this country, we talk about billions or trillions, but over 2 years this is only $15 million. Over 10 years it is only $68 million. That is not a lot of money. That is really peanuts in the grand scheme of things when we are talking about our Tax Code and other numbers that we talk about, when we talk about fixing our taxes in this country. This is real money for these soldiers in uniform.

I close with another picture of some heroes to remind us what this is all about, who we are trying to help. These soldiers, most of them, are relatively low-income because one has to be relatively low-income to even qualify for the earned income tax credit. They are leaving their families behind. Many of them are leaving jobs, homes, all kinds of economic security. Like I said, these are the folks who are taking care of us, and I think in the Senate and in the Congress we ought to do our part to take care of them.

Mrs. LINCOLN: Mr. President, I rise to join my colleagues Senators Pryor and Baucus in introducing legislation to ensure members of the military who serve in combat are not treated unfairly under the tax code. I believe strongly that we have an obligation in Congress to take care of the brave men and women in uniform who risk their lives to take care of us.

As my friend and colleague Senator Pryor mentioned, the provision in the Tax Code we are seeking to amend affects the ability of military personnel who serve in combat zones to benefit from the Earned Income Tax Credit. Due to an unintended consequence in the tax code, those affected may loose up to $4,000 in tax relief simply because they have volunteered to defend our freedom.

This is wrong.

We corrected the problem for 2 years--until 2006--in the Working Families Tax Relief Act which Congress recently approved but we didn't resolve the matter appropriately in my judgement. I offered an amendment during the conference report to bring tax relief for military families in line with the other provisions in the bill but that amendment was rejected.

I hope my colleagues will reconsider.

The men and women in uniform who serve in harm's way and their families here at home are the last people we should burden with uncertainty in the Tax Code. I think we should fix this problem without delay and that is why l am proud to join in this effort.

I applaud Senator Pryor for his leadership and hard work on this issue, and I yield the floor.

Mr. President, I rise today to introduce the Fair Access to Clinical Trials (FACT) Act. I want to begin by thanking Senator Kennedy, Senator Johnson, and Senator Wyden for joining me in introducing this legislation. Our bill will create a clinical trials registry--an electronic database--for drugs, biological products, and medical devices. Such a registry will ensure that physicians, the general public, and patients seeking to enroll in clinical trials have access to basic information about those trials. It will require manufacturers and other researchers to reveal the results of clinical trials so that clinically important information will be available to all Americans, and physicians will have all the necessary information to make appropriate treatment decisions for their patients.

Events of the past several months have made it clear that such a registry is needed. Serious questions have been raised about the effectiveness and safety of antidepressants when used in children and youth. It has now become clear that the existing data indicates that these drugs may very well put children at risk. However, because the data from antidepressant clinical trials was not publicly available, it took years for this risk to be realized. In the meantime, millions of children have been prescribed antidepressants by well-meaning physicians. While these drugs undoubtedly helped many of these children, they also led to greater suffering for others.

Unfortunately, antidepressants are just one example of a story that has become all too common. In the case of antidepressants, negative data might actually have been suppressed, and if this is discovered to be the case, those responsible should be dealt with harshly. However, because of what is known as ``publication bias,'' the information available to the public and physicians can be misleading even without nefarious motives. The simple fact is that a study with a positive result is far more likely to be published, and thus publicly available, than a study with a negative result. Physicians and patients hear the good news, but rarely the bad news. In the end, the imbalance of available information hurts patients.

Our bill would correct the imbalance of information, and prevent manufacturers from suppressing negative data. It would do so by expanding clinicaltrials.gov, an existing registry that is operated by the National Library of Medicine (NLM). Currently, clinicaltrials.gov includes information for patients seeking to enroll in clinical trials for drugs to treat serious or life-threatening conditions. The FACT Act would expand the registry to include all trials (except for preliminary safety trials), and would also require the submission of results data. At the same time, the bill would ensure that clinicaltrials.gov continues to operate as a resource for patients seeking to enroll in trials.

Our legislation would enforce the requirement to register trials in two ways. First, by requiring registration as a condition of Institutional Review Board (IRB) approval, no trial could begin without submitting preliminary information to the registry. This information would include the purpose of the trial, the estimated date of trial completion, as well as all of the information necessary to help patients to enroll in the trial.

Once the trial is completed, the researcher or manufacturer is required to submit the results to the registry. If they refuse to do so, they are subject to monetary penalties or, in the case of federally funded research, a restriction on future funding. It is my belief that these enforcement mechanisms will ensure broad compliance. However, in the rare case where a manufacturer does not comply, this legislation also gives the Food and Drug Administration (FDA) the authority to publicize the required information.

Let me also say that any time you are collecting large amounts of data and making it public, protecting patient privacy and confidentiality must be paramount. Our legislation would in no way threaten that privacy. The simple fact is that under this bill, no individually identifiable information would be available to the public.

I believe that the establishment of a clinical trials registry is absolutely necessary for the health and well-being of the American public. But I would also like to highlight two other benefits that such a registry will have. First, it has the potential to reduce health care costs. Studies have shown that publication bias also leads to a bias towards new and more expensive treatment options. A registry could help make it clear that, in some cases, less expensive treatments are just as effective for patients.

In addition, a registry will ensure that the sacrifice made by patients who enroll in clinical trials is not squandered. Many patients would be less willing to participate in trials if they understood that the data are unlikely to be made public if the results of the trial are negative. We owe it to patients to make sure that their participation in a trial will benefit other individuals suffering from the same illness or condition.

The problems associated with publication bias have recently drawn more attention from the medical community, and there is broad consensus that a clinical trials registry is one of the best ways to address the issue. Accordingly, the American Medical Association (AMA) has recommended the creation of such a registry, and the major medical journals have established a policy that they will only publish the results of trials that were registered in a public database before the trial began. Our legislation meets all of the minimum criteria for a trial registry set out by the International Committee of Medical Journal Editors.

To its credit, the pharmaceutical industry has also acknowledged the problem, and has created a registry to which manufacturers can voluntarily submit clinical trials data. I applaud this step. However, if our objective is to provide the public with a complete and consistent supply of information, a voluntary registry is unlikely to achieve that goal. Some companies will provide information, but others may decide not to participate. We need a clinical trials framework that is not just fair to all companies, but provides patients with peace of mind that they will receive complete information about the medicines they rely on.

The American drug industry is an extraordinary success story. As a result of the innovations that this industry has spawned, millions of lives have been improved and saved in our country and around the globe. Because of the importance of these medicines to our health and well- being, I have consistently supported sound public policies to help the industry to succeed. This legislation aims to build upon the successes of this industry, and help ensure that the positive changes to our health care system that prescription drugs have brought are not undermined by controversies such as the one now surrounding antidepressants, which is at least in part based on a lack of public information. This bill will help ensure that new and innovative medicines will be used by well-informed patients.

I look forward to working with industry, physicians, the medical journals, patient groups, and my colleagues to

move this legislation forward. This bill has already been endorsed by the National Organization for Rare Disorders, Consumers Union, the Elizabeth Glaser Pediatric AIDS Foundation, and the American Academy of Child and Adolescent Psychiatry. I thank these organizations for lending their expertise as we crafted this legislation, and I ask that a copy of their letters of endorsement be included in the Record after this statement.

Clinical trials are critical to protecting the safety and health of the American public, and for this reason, trial results must not be treated as information that can be hidden from scrutiny. Recent events have made it clear that a clinical trials registry is needed. Patients and physicians agree that such a registry is in the interest of the public health. I urge my colleagues to support this legislation, and I am hopeful that it will become law as soon as possible.

Mr. President, over the past year, I have come to this floor on a number of occasions to discuss the loss of manufacturing jobs in Wisconsin and around the country and ways in which I think that Congress should act to stem the flow of these jobs to foreign countries.

According to the Wisconsin Department of Workforce Development, Wisconsin has lost more than 80,000 manufacturing jobs since 2000. Nationally, according to the Bureau of Labor Statistics, the country has lost more than 2.8 million manufacturing jobs during that same time period. In addition to the loss of manufacturing jobs, I am deeply troubled by the Bush administration's contention that the outsourcing of American service sector and other jobs is good for the economy. I am concerned about the message that this policy sends to Wisconsinites and all Americans who are currently employed in these sectors.

There is something of a silver lining to the looming cloud of manufacturing and other jobs loss: the country's workforce development system.

In spite of stretched resources and long waiting lists for services, our workforce development boards are making a tremendous effort to retrain laid-off workers and other job seekers for new jobs. And this effort is clearly evident in Wisconsin, where my State's 11 workforce development boards are leading the way in finding innovative solutions to retraining workers for new careers on shoestring budgets.

I strongly support the work of these agencies, and have urged the administration and Senate appropriators to provide adequate funding for the job training programs authorized by the Workforce Investment Act. I regret that the administration's budget request for fiscal year 2005 does not provide adequate funding for WIA, and I will continue to work to ensure that the workforce development boards in my State and across our country receive the resources that they need to help job seekers get the training they need to be successful.

I am committed to finding resources to retrain those who have been laid off from the manufacturing and service sectors and who wish to find new jobs in high-demand fields such as health care.

As most of my colleagues know all too well, we are facing a significant shortage of health care workers. Congress has made some progress in addressing the nursing shortage, but we need to expand our efforts. Shortages of health professionals pose a real threat to the health of our communities by impacting access to timely, high-quality health care. Studies have shown that shortages of nurses in our hospitals and health facilities increase medical errors, which directly affects patient health.

As our population ages, and the baby-boomers need more health care, our need for all types of health professionals is only going to increase. This is particularly true for the field of long-term care. According to the Bureau of Labor Statistics, we are going to need an additional 1.2 million nursing aides, home health aides, and other health professionals in long-term care before the year 2010.

As our demand for health care workers grows, so does the number of jobs available within this sector. Currently, health services is the largest industry in the country, providing 12.9 million jobs in 2002. It is estimated that 16 percent of all new jobs created between 2002 and 2012 will be in health services. This accounts for 3.5 million new jobs--more than any other industry.

Workforce development agencies in my home State of Wisconsin are already working to support displaced workers in their communities by training them for health care jobs, since there is a real need for workers in these fields. These agencies are helping communities get and maintain access to high-quality health care by ensuring that there are enough health care workers to care for their communities.

As the executive director of one of the workforce development boards in my State put it, ``[t]here are simply not many good quality jobs to replace manufacturing jobs lost to rural communities. The medical professions, by offering a `living wage' and good benefits, provide an excellent alternative to manufacturing for sustaining a higher, family- oriented standard of living.''

I believe we need to support our communities in these efforts by providing them with the resources they need to establish, sustain, or expand these important programs. For that reason, today I am introducing the Community-Based Health Care Retraining Act. This bill would amend the Workforce Investment Act to authorize a demonstration project to provide grants to community-based coalitions, led by local workforce development boards, to create programs to retrain unemployed workers who wish to obtain new jobs in the health care professions. My bill would authorize a total of $25 million for grants between $100,000 and $500,000, and, in the interest of fiscal responsibility, it ensures that these grants would be offset.

This bill will help provide communities with the resources they need to run retraining programs for the health professions. The funds could be used for a variety of purposes--from increasing the capacity of our schools and training facilities, to providing financial and social support for workers who are in retraining programs. This bill is flexible in what the grant funds could be used for, because I believe that communities know best about the resources they need to run an efficient program.

This bill represents a nexus in my efforts to support workers whose jobs have been shipped overseas and to ensure that all Americans have access to the high-quality health care that they deserve. By providing targeted assistance to train laid-off workers who wish to obtain new jobs in the health care sector, we can both help unemployed Americans and improve the availability and quality of health care that is available in our communities.

I am pleased that this bill is supported by a variety of organizations that are committed to providing high-quality job training and health care services, including: the National Association of Workforce Boards, the American Health Care Association, the Wisconsin Association of Job Training Executives, Northwest Wisconsin Concentrated Employment Program, the

Northwest Wisconsin Workforce Investment Board, and the Southwestern Wisconsin Workforce Development Board.

I ask unanimous consent that the full text of this bill, and the text of the letters of support from the above-mentioned groups, be printed in the Record at the conclusion of my remarks.

In order to ensure that our workers are able to compete in the new economy, we must ensure that they have the tools they need to be trained or retrained for high-demand jobs such as those in the health care field. My bill is a small step toward providing the resources necessary to achieve this goal. I will continue to work to strengthen the American manufacturing sector and to support those workers who have been displaced due to bad trade agreements and other policies that have led to the loss of American jobs.

Mr. President, I rise to bring the Senate's attention to a bill I introduced today, the Long-Term Care Act of 2004.

Baby boomers will begin to turn 65 years old in 2010 and by 2030, all 77 million baby boomers will have reached retirement age and the over 65 population will have doubled. The practicality of these conditions will require the Federal Government and most State governments to spend more money on health care. Presently, Federal and State governments are spending billions of dollars to ensure the health and well being of our fellow citizens.

In one sector of the health care arena where costs are dramatically rising is in the area of long-term care. In 2000, spending on long-term care was estimated at $123.1 billion and it is expected to triple to $346.1 billion by 2040. Currently, 70 percent of long-term care costs are spent on nursing home care. The average cost of nursing home care is $178 per day or $60,000 per year. That is a significant burden on Federal and State governments as well as the thousands of individuals who pay for that care out of pocket.

In addition, almost 75 percent of nursing home care is publicly funded. Medicaid spends about 58.7 percent on long-term care while Medicare spends 14.7 percent. According to the Council for Affordable Health Insurance, by the year 2030, Medicaid's nursing home expenditures are expected to reach $130 billion a year.

If more people purchased private long-term care insurance, we could reduce Medicaid's future institutional-care expenses by more than $40 billion each year, while giving those who are insured alternatives to nursing homes: including home care, adult day care, foster care and assisted living. Congress has taken steps to give individuals more power to pay for their health care services such as long-term care. One such outstanding measure was the creation of Health Savings Accounts (HSAs).

Last year, I was pleased to support the passage of the Medicare Modernization Act. This landmark legislation

created Health Savings Accounts, which are a new way that people can pay for unreimbursed medical expenses such as deductibles, co-payments, and services not covered by insurance like long-term care. Eligible individuals can establish and fund these accounts when they have a qualifying high deductible health plan and no other health plan, with some exceptions. The beauty of these plans is that they have tax advantages such as deductible contributions; tax-exempt withdrawals if the individual uses the money for medical expenses; and tax-exempt account earnings.

I am confident that with the creation of Health Savings Accounts, individuals and families will be encouraged to set money aside for their health care expenses and give individuals the means to pay for health care services of their own choosing, without being constrained by insurers or employers. Unfortunately, Health Savings Accounts are relatively new and most individuals will not have the built up funds in their HSA to pay for a number of costly health care expenses such as long-term care insurance and that is why we need to provide other options to help pay for this important investment.

Currently, thousands of Virginians and millions of Americans are saving in their retirement plans to have a comfortable life once they become seniors, be it IRA, 401(k), and 403(b) accounts. These savings plans help prepare individuals for their future retirement or any unforeseen circumstance that may arise. Indeed, over 43 million Americans own IRAs with total savings of $2.5 trillion, while more than 47 million Americans have 401(k) accounts with $1.8 trillion saved. In addition, 6.4 million Americans have 403(b) accounts, amounting to over $590 billion saved.

These are untapped funds that individuals should be allowed to use to help pay for their future health care needs. Current tax law and some retirement plans allow individuals, in extreme circumstances, to withdraw funds from their retirement accounts, but more often than not, a 10 percent excise tax applies for early withdrawal. In my opinion, that tax precludes the ability or desirability of individuals to provide for their and their families well-being and that is why I have introduced legislation to provide a new health care option to help address this unfortunate circumstance.

My legislation, the Long-Term Care Act of 2004 will allow individuals to use their IRAs, 401(k), and 403(b) plans to purchase long-term care insurance with pretax dollars at any age and without early withdrawal penalty. Under the Long-Term Care Act, the consumer has the option to purchase long-term care insurance at the most appropriate amounts for their own needs and their spouses.

Today, only six percent of Americans own a long-term care policy. One of the reasons behind this dismally low figure is that individuals wait too long to purchase long-term care insurance. In fact, purchasing long-term care insurance at age 65 is about twice expensive as purchasing it age 55. That is why we must encourage individuals to plan for their future health care needs and purchase long-term care insurance at an early age. By purchasing long-term care insurance at a younger age, individuals will be saving money in the long run and not depleting their life savings.

Our country is heading towards a demographic melt down on long-term care costs. It is simply unsustainable for individuals and the government to maintain the current rate of spending without further endangering the state of health care in the United States.

Preparing for future costs of health care is something that every American should be doing. Long-term care insurance is one way for Americans to plan for periods of extended disability without burdening their families, going bankrupt or relying on government assistance.

Every American should be preparing for future health care costs and it is important that we encourage people to take responsibility today for those costs, be it with the purchase of long-term care insurance or investment in a Health Savings Account. If Virginians and Americans fail to act, it will result in an increased and unsustainable financial burden on the Federal Government and taxpayers.

My legislation, the Long-Term Care Act of 2004, is a commonsense approach that will encourage individuals to plan for their future health care needs and help make long-term care insurance more affordable. While this may not be the solution for some people, it is another option for the millions of Virginians and Americans to help provide for their health and well-being or the health and well-being of loved ones. I look forward to the Senate's action on this legislation early on in the 109th Congress because it not only encourages Americans to plan for their future health needs but will also help sustain the viability of our Nation's health care system.

Mr. President, our men and women serving in the military are the defenders of freedom and security around the world. The special role they play demands that they be ``on call'' to serve our Nation at points all over the globe.

The unique nature of their job has resulted in a unique and, I must say, very complex compensation package. The various types of compensation and benefits oftentimes create an especially difficult burden, especially when it comes to filing their tax return.

Through the years, Congress has periodically passed laws that recognize the special needs of our military and to lessen administrative burdens on them.

During consideration of such a bill last year, I approached the distinguished chairman of the Senate Finance Committee, Senator Chuck Grassley, and ranking member of that committee, Senator Max Baucus, and asked them to join me in an effort to get a fresh look at the overall picture of how the Tax Code treats our military.

I was pleased when they agreed to join me in this work, and I was delighted to jointly request an expedited study by the GAO. It has been an honor to work with them and their staffs throughout this process, and I believe our work will produce good things for our military.

Yesterday, GAO released a report as a result of our request. The report raises many interesting findings, but there is one especially important issue that demands our immediate attention. Mr. President, I want to discuss the problem identified by GAO, and then I will introduce a bill to correct the inequity that has been documented.

The problem identified by GAO is the result of complex interactions between the combat zone exclusion under section 112 of the Internal Revenue Code and the earned-income tax credit and the child tax credit.

Under the combat pay exclusion, a very important benefit provided by Congress, military pay earned--including basic pay, bonuses, special pay and allowances--is excluded from taxable income while members of the military are serving in a designated combat zone.

That is right, Uncle Sam doesn't impose taxes on military pay for those serving our country in combat zones--and rightfully so.

However, income excluded under the combat pay provision is also excluded from income for the purpose of computing the earned-income tax credit and the child care credit.

As a result of this, thousands of men and women serving in combat, in places such as Iraq, Afghanistan, and other places around the globe, will see a reduction or elimination of their earned-income tax credit or the child tax credit and, in effect, because of how these interact, will lose money. In other words, the Tax Code has the impact of penalizing them because they are serving in combat zones. That is the opposite effect intended by Congress.

The GAO report characterizes this result as an ``unintended consequence.'' I call it a wrong, and I urge my colleagues to join me in fixing this glitch as soon as possible.

The urgency of this situation is highlighted especially when you focus on those of our troops which this affects.

We are talking about troops who tend to be in combat for more than 6 months, who are not making much money, who have families to provide for and have little or no savings or little or no spouse income.

I am going to repeat that. We are talking about a clear wrong in the Tax Code that takes money away from men and women serving this Nation heroically and in dangerous places such as Iraq and Afghanistan.

The GAO analysis suggests the amount of the tax benefit loss enlisted personnel could face is up to $4,500 and $3,200 for officers. This is real money, make-or-break money, to many of these families who are already under an enormous amount of stress. This money will make a real difference and we need to get about the business of fixing this problem as soon as possible.

To correct the unfairness of current law, I am introducing the Tax Relief for Americans in Combat Act. The bill allows men and women in uniform serving in combat to include combat pay for the purpose of calculating their earned income tax credit and their child tax credit benefits. In other words, they will be able to continue receiving their rightful combat pay exclusions while having the ability to take full advantage of other tax credits. I urge my colleagues to join me in this effort. It will make a real difference for thousands of military families across the Nation.

I thank Liz Liebschultz and Christy Mistr of the Finance Committee staff for their advice and counsel in helping me sort through this matter in generating this GAO report. They did the work in drafting the provisions of this bill to make sure these provisions could be adopted by the Senate as soon as possible.

Also I want to recognize the GAO team which put this report together, because they did a lot of work on this: Jim White, Derek Stewart, Lori Atkinson, Jennifer Gravelle, John Pendleton, Sonja Ware, and James Wozny. They did a great job in preparing this report and I appreciate their hard work.

While we found this tax breakdown in the GAO report, there is also a lot of good news in the report regarding the compensation of our military personnel and I hope my colleagues will take time to review what the GAO says in all the information provided.

During a time of war, I do not want to lose sight that the Senate Armed Services Committee chairman, Senator John Warner of Virginia, and the ranking member, Senator Carl Levin of Michigan, are taking care of our troops financially.

One thing we talked about in the Armed Services Committee is recruiting and retention. Are we going to be able to meet those two objectives for our military? Well, I think today with this bill we can send a clear message to our youth and our enlisted personnel that a military career is an amazing option, and the compensation is such that it can compete with the private sector.

There is a real problem with our Tax Code that needs to be fixed immediately and the good news is, it can be. The bill corrects a problem and lets our troops risking life and limb know while they are away fighting for us, fighting for freedom and democracy, we will be in the Senate fighting for them and fighting for their families.

I urge my colleagues to consider this legislation and also to consider cosponsoring this bill with me.

I ask unanimous consent that a GAO summary, and the text of the bill, be printed in the Record.

I am pleased today to introduce the Fair Access to Clinical Trials or FACT Act. This needed legislation will improve the information available to patients and their families about the medical treatments they receive. For too long, drug companies have been able to hide damaging data that show their new wonder drug is not really the wonder they claim it to be. That practice ends on the day the FACT Act is enacted. From that day forward, consumers, doctors and researchers will have access to the results of clinical trials, so they can make informed decisions about treatment options.

No patient should ever die because they didn't get the information they needed on the medications they rely on to protect their health.

The legislation we introduce today is offered by a strong group of Senators and Representatives from across the nation. I commend my colleague, Senator Dodd, for his leadership in the Senate on this important measure. Senator Dodd has a strong and lasting commitment to improving the health and health care of all our citizens, and particularly for the youngest and most vulnerable. I am also pleased to join Senator Ron Wyden and Senator Tim Johnson in introducing this proposal, and I commend them for their commitment and skillful leadership in this area.

Our colleagues in the House of Representatives are today introducing almost identical legislation, and I commend our colleagues, Representative Ed Markey and Representative Henry Waxman, for their tireless efforts on this important issue.

As part of the FDA Modernization Act, Congress directed the Department of Health and Human Services to establish a registry of clinical trials. This provision was well timed, because it coincided with the rapid expansion of internet use. As a result, the National Library of Medicine has established a web site, clinicaltrials.gov, that is intended to contain information on all clinical trials for serious and life threatening diseases.

Sadly, recent studies show that drug manufacturers are not complying with the requirement to list even basic information on the trials they conduct. A recent study showed that only 48 percent of the required cancer trials were properly submitted to the registry, and rates for other serious diseases were in the single digits. As a result of this shameful failure, patients are being denied important information on clinical trials in which they may be eligible to participate.

Action is long overdue to give the NIH and the FDA better ways to see that companies and researchers properly register the trials they conduct. The FACT Act will assure that any researcher or sponsor seeking to conduct a clinical trial will be required, as a condition for approval to conduct the trial, to submit information on that trial to the clinical trial registry. This common-sense provision will see that patients seeking to enroll in clinical trials will have access to a complete set of information on the trials for which they may be eligible. No patient should be denied access to a lifesaving clinical trial because the sponsor of the trial shirked their responsibility to submit information to the national registry.

Ensuring that all trials are registered is important, but registration alone is not enough to see that patients get the information they need on the treatments they receive. We must also see that the results of clinical trials are included in the registry.

The FACT Act requires researchers and clinical trial sponsors to submit the results of their trials to the registry. With a complete and comprehensive set of information, patients will be better able to evaluate the treatments they receive, and physicians will have access to complete information on the treatments they prescribe. The FACT Act requires companies to list the results of trials--even when they show that a product is less effective than its manufacturers want to claim.

All of us are familiar with the way that drug companies hid information on potentially harmful side effects in children of antidepressants. Many of our Republican colleagues in the House forcefully criticized the FDA for failing to release information they possessed showing that these pills sometimes cause suicidal tendencies in the children who received them.

The FACT Act addresses both of these serious concerns. It requires companies to list the results of their trials, and gives FDA the authority to impose civil monetary penalties on those who fail to do so. It also gives FDA the clear legal authority to release information on the results of a clinical trial if a company fails to do so. No longer will FDA face the terrible dilemma of knowing that it possesses information crucial to assuring public health and safety, but is unable to release that information to the public because of legal constraints. The FACT Act assures that FDA has the clear authority to take the steps it needs to take to protect public health.

I urge Congress to take swift action on the proposals introduced today in the House and Senate. We have little time left in this session, but the measures introduced today have broad support from medical professional, consumer organizations and the publishers of professional journals.

Some companies have already taken voluntary steps to release information on clinical trials. These voluntary efforts are commendable, but they are inadequate to give the public the comprehensive information they need and deserve. Voluntary reporting efforts on the companies' own web sites will not result in a single, central database that every patient can consult. Sporadic efforts by individual companies will not elicit the comprehensive information needed on all clinical trials--not just those of the few companies that participate in the voluntary initiative. And voluntary efforts undertaken now may not be sustained in the future, when the hot glare of public attention fades from this issue.

To give patients and health professionals the information they need to improve the quality of medical care, we need a strong legal requirement to list comprehensive information on clinical trials in a single publicly accessible database. Patients and their families deserve the FACT Act, and I urge my colleagues to support it.